6.4.1: The top 10 leading causes of death for Americans in 2023

• Heart disease
• Cancers
• Unintentional injuries
• Stroke
• Chronic lower respiratory diseases
• Alzheimer disease
• Diabetes
• Kidney disease
• Chronic liver disease and cirrhosis
• COVID-19

Figure \(\PageIndex{1}\): Leading Causes of Death in the U.S., 2023. Adapted from Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database. Data are from the final Multiple Cause of Death Files, 2018-2022, and from provisional data for years 2023-2024, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-provisional.html on Aug 6, 2024.

Deaths at younger ages may be more concerning from a public health standpoint, since many of these deaths are below the average lifespan typically expected, and therefore they may be preventable. Those years lost from an early death include a loss of physical, emotional, and financial support to that individual’s family, and friends. That persons passing leaves a hole in the social fabric of their community. And, although it may seem trite to mention, there is also a significant economic impact from early deaths. The years of potential life lost or YPLL is another calculation used by epidemiology to express the number of deaths at younger ages, and the impact that those younger deaths have on the population. This YPLL is the difference between the age of deaths and a “standard year” of death - which is often set somewhere between 65-75 years of age. For example using the higher number, a child’s death at 5 years of age would have a YPLL of 70, whereas an older adult’s death at age 65 would have a YPLL of 10. Deaths above the standard year are not counted. It’s important to know the standard year used for this calculation, and why that particular number was chosen. This metric can be used for a specific disease, condition or a population. This calculation can be used to help focus public health efforts on preventing diseases with the greatest impact to younger populations (Seabert et al., 2021).

Sometimes the YPLL can also provide a more complete picture of the impact of a disease or condition than just the mortality rate alone. A great example of this is not a disease at all, but rather fatal accidents and violence - which tend to impact younger age groups the most heavily. Unintentional injuries (including car accidents and drug overdoses), homicide and suicide are leading causes of death for youths between 15-19 years of age (FastStats, 2023b). If we look at the data for unintentional injuries in 2021 overall, there were 224,935 deaths due to unintentional injuries. This equates to a crude (unadjusted) rate of 67.77 per 100,000 people, and an age-adjusted rate of 64.67 per 100,000. The age adjustment doesn’t have a large effect on the mortality rate, likely due to the fact that unintentional injuries are a leading cause of death for younger age ranges - that is, there isn’t an increasing risk of death with advancing age, like there may be with another cause of death like heart disease (which is a chronic disease, and therefore risk of death increases with age). The CDC calculated the number of years of potential life lost in 2021 due to unintentional injuries at 3,781,756 - which demonstrates the significant impact that this cause of death has on American society (WISQARS Fatal and Nonfatal Injury Reports, n.d.).

Still other metrics attempt to quantify the impact of chronic disease and disability on populations. Sometimes the term healthy life expectancy (HALE) is used to determine how many average years a person can expect to live before experiencing debilitating effects of chronic disease. This number varies depending on the age we begin counting from, so often HALE at birth is used to determine a lifespan estimate and HALE60 - or healthy life expectancy at 60 years is used to describe the burden of disease and disability on our current aging population. For example, according to data from the World Health Organization, HALE60 in the U.S. in 2019 was 16.35 years - so someone at age 60 in 2019 could have expected to live on average another 16 or so years without disability. In the same year, Canada’s HALE 60 was 18.99 years - demonstrating that Canada has a longer HALE60, and perhaps slightly lower burden of disease on their aging population (World Health Organization, 2023b).

Years lost to early death or chronic disease are also sometimes combined with years of life under which a person experiences life-altering disability. This metric is termed disability adjusted life years (DALYs), where one DALY equals a year of healthy life lost either to premature death or to disability. The World Health Organization has estimated the top diseases and conditions which are the highest sources of DALYs for countries around the world. In 2019, the leading causes of years lost to premature death and disability included (in order) (World Health Organization, 2023a):

• Ischemic heart disease
• Drug use disorders
• Chronic obstructive pulmonary disease
• Diabetes mellitus
• Neck and back pain
• Alzheimer disease and dementias
• Stroke
• Cancers of the lungs, trachea and bronchi
• Depressive disorders
• Self-harm

This list demonstrates that the leading causes of disability and premature death may not always be the same as the leading causes of death. Using these other metrics like YPLL and DALY allows for epidemiologists to get a fuller picture of not only how long a population is living, but how healthy those years are, and the causes of harm experienced.